Developmental difficulties in children account for significant childhood morbidity worldwide and have a substantial impact not only on the lives of the affected children but also their families and communities and continue to have economic consequences as these children mature through the lifespan. In the U.S., the benefits of early identification of developmental difficulties have long been recognized and it is now well established that the optimal approach is to use standardized screening instruments administered at health care visits. In resource-poor countries, however, where developmental difficulties are more prevalent, little attention is paid to the early identification and management of such problems, despite the fact that, for many disorders, there are simple, low-cost, interventions, such as iron therapy or counseling about infant stimulation. This study will start to address this global disparity by further developing an instrument, the Guide for Monitoring Child Development (GMCD), which was developed in Turkey, to guide health clinicians in the early detection and management of developmental difficulties in children aged birth to 3 years. The overall goal of the study is to develop the GMCD so that it can be used internationally in countries with diverse cultures and different languages. Thus, the specific aims of the research are to: 1. Standardize the GMCD in four countries (Turkey, South Africa, India and Eritrea) that have very different demographic, cultural and linguistic characteristics so as to make it appropriate for universal use. 2. Establish valid scoring criteria for the GMCD that enables accurate detection of developmental difficulties when used in different cultures and languages. 3. Conduct a pilot study in the four countries to identify approaches to implementing and sustaining ongoing developmental monitoring using the GMCD in community health clinics and assess to what extent identification of developmental difficulties using the GMCD results in access to services and appropriate management of developmental difficulties. The study will be conducted in three phases. In Phase I, children aged 0-42 months will be enrolled in a standardization study at multiple sites in each of the four countries to determine at what ages children attain the GMCD developmental milestones and whether there are consistencies or differences between cultures. Phase II will be conducted in all four countries to establish the validity of the GMCD developmental milestones and total score using different cut-off and scoring criteria by comparing its use to a "gold standard" comprehensive developmental evaluation. In Phase III the GMCD will be implemented in two pilot sites in each country using a participatory research approach to identify ways of achieving and sustaining high rates of developing monitoring by clinicians. Follow-up interviews will be conducted two months later with caregivers of children identified with developmental difficulties, to determine to what extent these have been addressed. PUBLIC HEALTH RELEVANCE: There is presently no universally accepted, easily administered method of identifying and monitoring developmental difficulties in young children in resource-poor countries, despite the severe consequences that such difficulties have on children and their families. This study will result in an easily administered method for detecting and monitoring developmental difficulties that has proven accuracy when used in different cultures and languages. Future dissemination and training in the use of this instrument has the potential to benefit large numbers of children worldwide.